Transcription of HEAD START/EARLY HEADSTART ENROLLMENT APPLICATION
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HEAD START/EARLY HEADSTART ENROLLMENT APPLICATION
G:\ERSEA\Forms\ head start \ head start - early head start ENROLLMENT APPLICATION Revised. 1/11/17 head start & early head start ENROLLMENT APPLICATION THE CHILD S INFORMATION EHS-CCP EHS HS LIFT Child s Legal Name First Middle Initial Last Child s Place of Birth (City, State) Child s DOB (mm/dd/yyyy) Sex Child s Ethnicity Latino Yes No Child s Race Pacific Islander Black White Biracial/ Multi Nat. Amer. Asian Other_____ Child s Primary Language English Spanish Vietnamese Other _____ Child s Secondary Language English Spanish Vietnamese Other _____ THE CHILD S HOUSEHOLD FAMILY INFORMATION 1 Primary adult name Latino?
G:\ERSEA\Forms\Head Start\Head Start-Early Head Start Enrollment Application English.doc Revised. 1/11/17 First & Last Name of Children in Home
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